HomeMy WebLinkAboutMysliborski permitAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
ti:. D,
Building Permit Application
Planning and Development Services
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT .LOCATION:
Address: `l qo mm W00I Z)i• 11wl r -
Property Tax ID #: --JSA7 `1D3 Oew 000 f' Lot No,
Site Plan Name: CXUA-[L
Project Name:
DETAILED DESCRIPTION OF WORK:
Block No.
hu4 l etiv w wi-srw'2- Mym� E;L y b'Z Z` s L Dooh. W l r�
New Electrical Meter Second Electrical Meter
CONSTRUCTION INFORMATION.
Additional work to be performed under this permit– check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters
Electric _ Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction:
Cost of Construction: $
Sq. Ft. of First Floor:
Windows/Doors _ Pond
_ Roof Pitch
Utilities: —Sewer _Septic Building Height:
Name 'TWDOW
W
Address: M0 NotPOW004 pjt°. t(Pff)O;
City: _11�kr kP(&"w– State: _
Zip Code: 3Y—fS7 Fax:
Phone No.
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: 1111 /,a
Company:, cYLS,unl�blaQlsD1�8 %1iC
Address: R37 hw
City: ; P/dpi e - State:
Zip Code: _3i9�,5� Fax: ?--)l - 33
Phone No 7? -LIP l
E -Mail -Now 6 &1oee YT, Oyn
State or County License C12C 1133
it value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: _ Not Applicable
Name:_
Address:
City:
Zip:
Phone:
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
te:
Not Applicable
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
in accordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review: room additions,
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
WARNING TO OWNER: Your failure to Record a Notice of Commencement may result in paying twice for
improvements to your property. A Notice of Commencement must be recorded in the public records of St.
Lucie County and posted on the jobsite before the first inspection. If you intend to obtain financing, consult
with lender or an attornev before commencine work or recordine vour Notice of Commencement.
Rev.
Signature of Owner/ Lessee/Contrac or as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA^^ // +
STATE OF FLORIDA +
COUNTY OF /)1 _
COUNTY OF . 44C
Sworn to (or affirmed) and subscribed before me of
Sworq to (or affirmed) and subscribed before me of
/Physical Presenceor Online Notarization
Physical Pre ence or Online Notarization
this L day of 2020 by
this 7 day of 2020 by
6�Lx__3 ptuu—
a-4—
Name of person making statement.
Name of person making statement.
Personally Known ✓ OR Produced Identification
Personally Known ✓ OR Produced Identification
Type of Identification
Type of Identification
Produced
Aignture
Produced
(Signature of Notary Pub
x GG 198881
ofotary LMic ,teAki ## G198661
a; Expires July 2, 2022
Commission No. ►��. MrAWT%t*h Inwuic $$38510±5
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SUPERVISOR
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DATE
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DATE
COMPLETED
Rev.
10/6/2020 63055B3E-1 1 79-4DC6-B68D-9D2544A6A54D.jpeg
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